Acute Spinal Subdural Haematoma Complicating a Posterior Spinal Instrumented Fusion for Congenital Scoliosis: A Case Report

Overview

Journal World J Clin Cases

Publisher Baishideng Publishing Group

Specialty General Medicine

Date 2023 Aug 16

PMID 37583984

Authors

Godefroy Michon du Marais

Anne Tabard-Fougere

Romain Dayer

Affiliations

Soon will be listed here.

Abstract

Background: Acute spinal subdural haematoma (ASSH) is a rare and potentially devastating condition with a variable prognosis. Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery, spinal puncture or epidural anaesthesia. Other contributing pathologies have been described, such as intradural tumours or spinal arteriovenous malformations. ASSH has also been associated with anticoagulation therapy, haemostatic abnormalities and risk factors such as pregnancy. To the best of our knowledge, this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient. The patient was not known to have any coagulopathies, and no obvious vascular lesions were documented. The surgical procedure did not directly involve the dura mater, and no evident intraoperative dural tears were found.

Case Summary: We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis. This condition has not been previously described. We made recommendations for facing such an occurrence, explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol. We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders. We reviewed recommendations regarding neuromonitoring and treatment management in such cases.

Conclusion: ASSH is a rare complication of posterior spinal instrumented fusion. Published cases are more often associated with anticoagulation therapy or coagulopathy. Neuromonitoring is strongly recommended to detect and assess neurological status, thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.

References

Yang N, Kim S, Cho Y, Cho D . Spontaneous resolution of nontraumatic acute spinal subdural hematoma. J Korean Neurosurg Soc. 2011; 50(3):268-70. PMC: 3218192. DOI: 10.3340/jkns.2011.50.3.268. View

Gehri R, Zanetti M, Boos N . Subacute subdural haematoma complicating lumbar microdiscectomy. J Bone Joint Surg Br. 2000; 82(7):1042-5. DOI: 10.1302/0301-620x.82b7.10169. View

Kyriakides A, Lalam R, El Masry W . Acute spontaneous spinal subdural hematoma presenting as paraplegia: a rare case. Spine (Phila Pa 1976). 2007; 32(21):E619-22. DOI: 10.1097/BRS.0b013e318154c618. View

Oh S, Han I, Koo Y, Kim O . Acute spinal subdural hematoma presenting with spontaneously resolving hemiplegia. J Korean Neurosurg Soc. 2009; 45(6):390-3. PMC: 2711240. DOI: 10.3340/jkns.2009.45.6.390. View

Nakamura T, Watanabe G, Harada R, Kawasaki E, Tsukita K, Suzuki Y . Acute Intracranial and Spinal Subdural Hematoma Associated with Vardenafil. J Stroke Cerebrovasc Dis. 2018; 27(9):e201-e202. DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.006. View

Kang H, Chung C, Kim H . Spontaneous spinal subdural hematoma with spontaneous resolution. Spinal Cord. 2000; 38(3):192-6. DOI: 10.1038/sj.sc.3100967. View

Yamada K, Nakahara T, Yamamato K, Muranaka T, Ushio Y . Nontraumatic spinal subdural haematoma occurring in a postpartum period. Acta Neurochir (Wien). 2003; 145(2):151-5; discussion 155. DOI: 10.1007/s00701-002-1045-z. View

Mattei T, Rehman A, Dinh D . Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion. Global Spine J. 2015; 5(5):e52-8. PMC: 4577316. DOI: 10.1055/s-0035-1544155. View

Tropeano M, La Pira B, Pescatori L, Piccirilli M . Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report. World J Clin Cases. 2017; 5(8):333-339. PMC: 5561502. DOI: 10.12998/wjcc.v5.i8.333. View

10.

Chang K, Samartzis D, Luk K, Cheung K, Wong Y . Acute spinal subdural hematoma complicating lumbar decompressive surgery. Evid Based Spine Care J. 2012; 3(1):57-62. PMC: 3503516. DOI: 10.1055/s-0031-1298602. View

11.

Cha Y, Chi J, Barbaro N . Spontaneous spinal subdural hematoma associated with low-molecular-weight heparin. Case report. J Neurosurg Spine. 2005; 2(5):612-3. DOI: 10.3171/spi.2005.2.5.0612. View

12.

Boe C, Freedman B, Kumar R, Lee K, McDonald R, Port J . Spinal subdural hematoma: a rare case of spinal subdural hematoma complicating routine, minimally invasive lumbar discectomy and decompression and relevant literature review. J Spine Surg. 2017; 3(1):112-118. PMC: 5386888. DOI: 10.21037/jss.2017.03.01. View

13.

de Beer M, Eysink Smeets M, Koppen H . Spontaneous Spinal Subdural Hematoma. Neurologist. 2016; 22(1):34-39. DOI: 10.1097/NRL.0000000000000100. View

14.

Schwartz D, Auerbach J, Dormans J, Flynn J, Bowe J, Laufer S . Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am. 2007; 89(11):2440-9. DOI: 10.2106/JBJS.F.01476. View

15.

Dawson E, Sherman J, Kanim L, Nuwer M . Spinal cord monitoring. Results of the Scoliosis Research Society and the European Spinal Deformity Society survey. Spine (Phila Pa 1976). 1991; 16(8 Suppl):S361-4. View

16.

Kim Y, Cho K, Chung C, Kim H . Idiopathic spontaneous spinal subarachnoid hemorrhage. Spinal Cord. 2004; 42(9):545-7. DOI: 10.1038/sj.sc.3101620. View

17.

Domenicucci M, Ramieri A, Ciappetta P, Delfini R . Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature. J Neurosurg. 1999; 91(1 Suppl):65-73. View

18.

Benyaich Z, Laghmari M, Lmejjati M, Aniba K, Ghannane H, Ait Benali S . Acute Lumbar Spinal Subdural Hematoma Inducing Paraplegia After Lumbar Spinal Manipulation: Case Report and Literature Review. World Neurosurg. 2019; 128:182-185. DOI: 10.1016/j.wneu.2019.05.002. View